Topic: Terms of Engagement: Opening the Dialogue
Terms of Engagement: Opening the Dialogue
Written May 2010
The 2009 Annual Quality and Disparities Report issued in April by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ) includes a new section on lifestyle modifications1. It was added chiefly because preventing or reducing obesity in this country has become a national priority. Today lifestyle modifications for weight management represents a crucial goal for many Americans and thus an important task for healthcare providers, especially those practicing in primary care. Health Central spotlights obesity with priority equal to incontinence an all other medical conditions considered to have widespread prevalence. Interestingly, research has demonstrated a direct link between obesity and stress urinary incontinence, as studies show that as little as 10% reduction in body mass in overweight women cuts the amount of urine leakage in half and results in sustainable, significant improvements in bladder control.
Sadly, the report found that one-third of obese adults have never received advice from their doctor about exercise. On the topic of weight loss, obese adults who are black, Hispanic, poor or have less than a high school education are less likely to receive diet advice from their doctor than those who are Caucasian, from middle and upper income households, and who are more highly educated. Even more alarming is the fact that most overweight children and one-third of obese adults report they have not been told by their doctor that they are overweight. It is clear from these findings and other research published on the subject that our medical community is not comfortable opening discussion about weight management, much less trained in how to offer strategies and tactics for weight loss including the role of exercise, especially in minority and disadvantaged populations.
As often the question with other sensitive health topics, such as bladder and bowel control, whose place is it to open the discussion, the patient or the doctor? So often the doctor is criticized for not taking initiative. Certainly, if the doctor unearths a medical problem that the patient has no other means or readily identifying, such as a heart murmur or arrhythmia, the physician is ethically under and obligation to address it. However, in the case of leakage or urgency, the patient needs to reveal what's happening and be prepared to speak about the frequency and severity of episodes for engagement to take place between the two parties. Even in the case of obesity, so obvious by observation, the patient needs to voice at least concern to the doctor about carrying excess weight and thus show willingness to address the problem for behavioral intervention to have a chance of being successful. Otherwise, a doctor's intervention will be futile, particularly where behavioral therapies are concerned. This is also the first step of engagement: framing the patient's expectations.
Health seeking behavior naturally begins with the patient and can have successful outcomes only when the patient is engaged in intervention, including lifestyle modifications, looking for change, and eager for a positive outcome.
Remain aware of how responsibly you are playing your role as patient. Be engaging and give intervention its greatest chance of success.
Nancy Muller
Executive Director
1Annual Quality and Disparities Reports Include Data on Rates of Health Care-Associated Infections, Obesity and Health Insurance, April 13, 2010, Agency for Healthcare Research and Quality, accessed on May 21, 2010 at http://www.ahrq.gov/news/press/pr2010/qrdr09pr.htm
